Appeal Process for SSDI Denial [Sample Disability Appeal Letter]

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More often than not, disability applicants will receive at least one disability claim denial letter. Most people, receive two SSDI claim denials when filing on their own. This can be devastating if you are out-of-work with few options.

If you are denied disability benefits by the SSA, try not to be discouraged and vow to continue fighting. Although the Social Security Administration (SSA or the Administration) does not always get it right, claimant’s that are truly disabled almost always win in the end.

How Long Do I Have to File a Disability Claim Appeal?

The most important part of the disability benefits appeals process is to ensure that you file your appeal on time. Generally speaking, you have 60 days from the date you receive the denial to make an appeal. The SSA assumes that you received the appeal 5 days after the date on your denial. Said another way, you have 65 days from the date on your denial. If you are able to show that your denial took more than 5 days to arrive at your residence, you will be given 60 days after actual receipt of the denial to file your appeal.

If you fail to appeal your denial within the 60-day time limit, you could lose your right to appeal. In the event that you lose your right to appeal your disability claim, the prior decision will be the Administration’s final decision. If you have good reason for not making a timely appeal, the Administration may give you additional time. You will need to make a request for more time and explain to the Administration your reasons. The likelihood of getting more time is entirely dependent on your reasoning and any supporting documentation you are able to include in your request.

As an aside, if the last day to appeal falls on a Saturday, Sunday, or a national holiday, the time limit extends to the next workday.

How to File an Appeal

In the event you receive an unfavorable determination, you need to make your appeal in writing. You can make a Request for Reconsideration or make a Request for a Hearing by an ALJ online. In my experience, making your appeal online is the fastest and most convenient way. You can start the process whenever you want and can pause and restart the process at your own convenience. You may also call 1-800-772-1213 or contact your local Social Security office to request the appeal forms. For your convenience, links to the actual forms are included below.

1. Request for Reconsideration

The first appeal is called a “Request for Reconsideration”. This appeal occurs if your initial application is denied. In order to make a Request for Reconsideration, you must fill out three forms which can be completed online or in paper form.

Request for Reconsideration

Disability Report – This allows you to update your medical information

Authorization to Disclose Information to the SSA – This allows the SSA to obtain any additional medical evidence.

2. Request for a Hearing by an Administrative Law Judge

The second appeal is a request to have your claim heard by an Administrative Law Judge. This appeal occurs if your Request for Reconsideration is denied. There are three forms that need completed for this appeal as well.

Request for Hearing by an Administrative Law Judge

Disability Report – This allows you to update your medical information

Authorization to Disclose Information to the SSA – This allows the SSA to obtain any additional medical evidence.

At each level the SSA provides you with three lines to explain why you disagree with the SSA’s determination. Specifically, the Request for Reconsideration form and the Request for Hearing by an Administrative Law Judge form have these areas. It is probably obvious that any well thought out response will take more than three lines. You are able to simply write “See Attached” and include a Disability Appeal Letter.

3. Disability Appeal Letter

If you elect to attach a disability appeal letter, you need to include your name and your claim number at the top. This will ensure that the letter makes its way into your file even if it becomes detached from your application. You can find a sample disability appeal letter below.

Prior to writing your letter, you should read the denial. Although it is unlikely that your denial will be very detailed, you will be able to dig out certain facts from it. Specifically:

-It will list your “severe ailments”, which are the ailments that the SSA evaluated;

  • It will list all of the medical records that were reviewed in making the decision; and
  • It will state the reason for the denial, likely stating something about you being able to perform work or being able to perform your past work.
Social security administration office of disability adjudication and review. The social security administration's (ssa) administrative appeals operation is one of the largest administrative judicial systems in the world.

SSA Office in New York. Lookup the address of your local SSA Office for Disability Adjudication & Review on SSA.gov.

4. Request for Reconsideration

In the request for reconsideration appeal, the most important thing you can do is point out missing evidence. You need to ensure that the decision-maker had every relevant piece of evidence at his or her disposal when the decision was made. In your initial application, you were asked to make a list of all of your medical providers. Make sure that the providers listed in your decision matches exactly with the list your provided in your application. If something is missing, you should point it out in your Disability Appeal Letter. Also, if you forgot a provider, you should include it in this letter. You could also call your medical provider and ask why the SSA did not receive it as some providers fail to respond to medical record requests. In some instances, you could even go so far as getting those records yourself and including them with your letter.

I think the second most important thing you can do is point out any of your ailments that were not considered. I suspect that any missing ailments will be included in missing medical records, but you should point them out anyway.

Lastly, if your medical provider will fill out an RFC, you should include that with your letter. RFCs should be completed at all levels of the application process, the earlier they are included and the more often they are updated, the better.

5. Request for a Hearing by an Administrative Law Judge

5a. Hire a Disability Lawyer to Handle Your SSDI Hearing

In the request for a disability claim hearing by an Administrative Law Judge appeal, you should really consider hiring an attorney if you qualify for assistance. You’ll pay nothing out-of-pocket if they take your claim. DisabilityQualification.com has a free disability case assessment that determines if any Disability lawyers can take your claim. If you qualify, you’ll have a chance connect you with a Disability Specialist that will provide a free over-the-phone consultation if you qualify.

Even if you decide to proceed on your own, this free SSD appeal consultation is useful. Click here to take a quick preliminary SSDI appeal assessment to see if you qualify for free SSD appeal help.

5a. Continue with Disability Appeal without Legal Assistance

If you are electing to go it alone, you should repeat the process listed above, but you need to know that at this stage in the Disability Appeal process, you are responsible for obtaining all outstanding medical evidence that is relevant to your disability claim. Pointing it out in your appeal likely will not have much of an impact on the outcome of your hearing. It will; however, alert you about any evidence that was missing at the Request for Reconsideration level. This will help you ensure that it is available for the administrative hearing.

Further, if it were me, I would save my energy and effort by not writing an Appeal Letter at this stage. I would instead write an argument for disability at least a week before my actual disability hearing. Waiting will ensure that my argument contains the most recent and up-to-date evidence as updating the medical evidence should be an action performed prior to the actual disability claim hearing.

Disability Appeal Letter Example

Above we mentioned the sample disability appeal letter below. you’ll find a sample Disability Appeal Letter written by an experienced disability lawyer. If you choose to submit it on your own, this would be a great place to start. If you need assistance, please feel free to use our Disability Case Evaluation to connect with a free Disability Specialist who will determine if you are eligible for Disability attorney that only gets paid if you win your claim.

DATE Social Security Administration Attn: Disability Appeals Department Street Address City, State, ZIP Re: Name, Claim Number Dear sir or mam: I am in receipt of a letter denying my application for disability. Please accept this letter requesting that your decision on my application be reconsidered. Of particular note, the following medical evidence was not considered in your decision: Provider name Street Address City, State, Zip Phone Fax Dates of Treatment Additionally, please be aware of the following symptoms that would prohibit me from engaging in substantial gainful employment. A list of symptoms and a brief statement as to how those symptoms would impair your ability to work Also, please find attached the following additional medical evidence. Include any missing or additional evidence, including, but not limited to any not yet submitted RFCs Lastly, I would like it to be known that I am prepared to fully cooperate in any testing or interviews to help substantiate my claim. Thank you for your time, Name

 

FAQ for Appeal Process

How Do I File an Appeal for SSDI Denial?

When appealing an unfavorable disability benefits determination, it is important to file the appeal on time. The two types of appeals are the Request for Reconsideration and the Request for a Hearing by an Administrative Law Judge (ALJ). Filing the appeal online is the fastest and most convenient option. The necessary forms can be completed online or on paper, including the Disability Report and Authorization to Disclose Information to the SSA. It is advised to attach a Disability Appeal Letter, addressing missing evidence and ailments not considered. For the ALJ appeal, consider hiring a disability lawyer for assistance. As the process progresses, obtaining relevant medical evidence becomes the claimant's responsibility. Writing an argument for disability closer to the hearing date allows for the inclusion of the most up-to-date evidence.

How Long Do I Have to File a Disability Claim Appeal?

Filing your disability benefits appeal on time is crucial. Generally, you have 60 days from receiving the denial to appeal, with the assumption that you received it 5 days after the denial date. If you can prove a delayed receipt, you'll have 60 days from actual receipt. Failing to appeal within this timeframe can result in losing your right to appeal. You may request additional time with valid reasons, and appeals falling on weekends or holidays extend to the next workday.

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November 17, 2022

Written by Disability Qualification

Disability Qualification is a resource for people who need help applying for SSDI or SSI Benefits.

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